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Finding the Exit Door: Why Some Physicians are Leaving Hospitals

Emergency medicine physicians are leaving behind their emergency rooms and opening primary care practices, which does not necessarily translate to a smooth transition with some inherent challenges associated with training and expectations.

Emergency room (ER) physicians were on the frontlines during the pandemic seeing patients who in many cases could not be treated. Just this alone, put a lot of stress on these health care workers who were hit by overwhelming amounts of responsibility, and subsequent fatigue and anxiety associated with the pandemic.

Another ongoing issue has been contract management groups buying up physician services, according to Rebekah Bernard, MD, owner of Gulf Coast Direct Primary Care in Fort Myers, Florida. These private equity firms are controlling physician services and compensation. “If you don’t like as a physician the way they are charging patients or paying, you can leave,” Bernard said. “The problem is as more and more of these organizations buy up staffing for emergency departments in your area, there might not be anywhere else to work.”

As such, many ER physicians have been left feeling burnt out or they have no choice but to work for these firms, which makes looking for an alternative to the hospital environment very attractive.

One landing spot for ER physicians has been primary care and opening private practices. Although on the surface this sounds reasonable there are some challenges in transitioning from emergency medicine to primary care.

Primary care practices are not designed to be run by ER physicians who are seeking to escape the challenges associated with burn out, insurance billing, and quality reporting standards that regulate hospitals.

Physicians for Patient Protection (PPP) is a non-profit organization that is raising awareness around this topic. Bernard is a PPP member, and acknowledges the shortage of primary care physicians overall but also says that if ER physicians are transitioning to primary care, additional training is needed.

“If you are going to expand primary care, and allow others—other than primary care physicians to provide it—an ER doctor could potentially step into that role; now they would require additional training,” Bernard explained. She also says that ER physicians are somewhat equipped to make this transition as they have had some education around primary care and in some ER settings they are treating some people who are using the ER as a primary care setting, so these physicians understand and treat chronic conditions like blood pressure and blood sugar management.

Contagion spoke to Bernard who provided some insights into the issues facing ER physicians and the challenges of transitioning to primary care.